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To assist in identifying any patient in an at risk group
14Od. At risk of dementia
To record initial questioning for memory concern (or offer)
38C15 Initial memory assessment.
8IE50 Initial memory assessment declined
To record an assessment (or offer) for dementia in patients with a memory
38C10 Assessment for dementia
8IEu. Dementia screening declined
8IEu0 Dementia screening questionnaire declined
To record any referral (or offer) for a diagnosis of dementia
8HTY. Referral to memory clinic
8IEn. Referral to memory clinic declined
To record advance care planning
8CSA. Dementia advance care plan agreed
8CMG2 Review of dementia advance care plan
8IAe0 Dementia advance care plan declined
To record, for diagnosed patients, any identified carer and offer of a health
check where the carer is registered with the practice
918y. Carer of person with dementia
69DC. Carer annual health check
8IEP. Carer annual health check declined
Excluded if no longer a carer recorded.
918f. Is no longer a carer
Improving diagnosis and care of patients with dementia has been prioritised by the Department of Health through the NHS Mandate and by NHS England through its planning guidance for CCGs. This enhanced service is designed to encourage practices to take a proactive approach to the timely assessment of patients who may be at risk of dementia.
For patients with dementia, their carers and families, the benefits of timely diagnosis and referral will enable them to plan their lives better, to provide timely treatment if appropriate, to enable timely access to other forms of support and to enhance the quality of life.
The aims of this enhanced service are to encourage practices to identify patients at clinical risk of dementia, offer an assessment to detect for possible signs of dementia in those at risk, offer a referral for diagnosis where dementia is suspected and in the case of a diagnosis, provide advanced care planning in line with the patient's wishes, The ES also aims to increase the health and wellbeing support offered to carers of patients diagnosed with dementia.
A system-wide integrated approach is needed to enable patients with dementia and their families to receive timely diagnosis and to access appropriate treatment, care and support. National tools and levers need to be aligned to support local system-wide improvements:
This enhanced service is designed to support practices in contributing to these systemwide improvements by supporting timely diagnosis, supporting individuals and their carers an integrated working with health and social care partners.
The specification and guidance for the 2014/15 ES expands on the 2013/14 guidance in that it now requires contractors to provide a more comprehensive care plan for patients diagnosed as having dementia and increase support provided to carers.
This ES is for one year from 1 April 2014.
Area teams will seek to invite practices to participate in this enhanced service before 30 April 2014. Practices wishing to participate will be required to sign up by no later than 30 June 2014.
The requirements for this ES are:
A. The practice undertakes to make an opportunistic offer of assessment for dementia to 'at-risk' patients on the practices registered list, where the attending practitioner considers it clinically appropriate to make such an offer. Where an offer of assessment has been agreed by a patient then the practice is to provide that assessment. For the purpose of this ES, an opportunistic offer means an offer made during a routine consultation with a patient identified as 'at risk' and where there is clinical evidence to support making such an offer. Once an offer has been made, there is no requirement to make a further offer during any future attendance, but it is expected that attending practitioners will use their clinical judgement for any concerns raised by the patient or their carer.
B. For the purposes of this enhanced service, 'at-risk' patients are:
These assessments will be in addition to other opportunistic investigations carried out by practices for whom the attending practitioner considers to have a need for such investigations (i.e. anyone presenting raising a memory concern).
C. The assessment for dementia offered to at-risk patients shall be undertaken only following the establishment of patient consent to an enquiry about their memory
D. The assessment for dementia offered to consenting at-risk patients shall be undertaken following initial questioning (through appropriate means) to establish whether there are any concerns about the attending patient's memory (GP, family member, the person themselves)
E. The assessment for dementia offered to consenting at-risk patients for whom there is concern about memory (as prompted from initial questioning) shall comprise administering a more specific test (where clinically appropriate) to detect if the patient's cognitive and mental state is symptomatic of any signs of dementia, for example the General Practitioner assessment of Cognition (GPCoG) or other standardised instrument validate in primary care
F. The assessment of the results, for the test to detect dementia, is to be carried out by healthcare professionals with knowledge of the patient's current medical history and social circumstances
G. If as a result of the assessment the patient is suspected as having dementia the practice should:
H. Patients diagnosed as having dementia will be offered a care planning discussion focussing on their physical, mental health and social needs and including referral/signposting to local support services.
I. The care plan should, where possible and through encouragement from the attending practitioner, include a recording of the patient's wishes for the future. It should identify the carer(s) and give appropriate permissions to authorise the practice to speak directly to the nominated carer(s) and provide details of support services available to the patient and their family. For the purpose of this service, 'carer' will apply to a person - usually a family member, friend or acquaintance who takes responsibility for the patient's care needs but will not include professional carers who have been employed for this purpose by the patient or their representative.
J. The care plan should be shared with the patient and their carer(s), being reviewed on an appropriate basis.
K. The practice will seek to identify any carer (as defined above) of a person diagnosed with dementia and where that carer is registered with the practice offer a health check to address any physical and mental health impacts, including signposting to any other relevant services to support their health and well-being.
L. Where the carer of a patient, on a practice's register, who is diagnosed with dementia is registered with another practice, the patient's practice will inform the patient's carer that they can seek advice from their own practice.
M. The practice should record in the patient record relevant entries including the required Read2or CTV3 codes to identify where an assessment for dementia was undertaken, where applicable, that a referral was made and patients diagnosed, as well as whether or not an advance care planning discussion was given or declined. The practice should record in the carer record relevant entries including the required Read2or CTV3 codes.
There are two payment counts and 16 management information counts for the service. The two payment counts are an upfront payment and an annual end year payment. The upfront payment is not supported by CQRS. The end year payment reflects the number of completed assessments carried out per practice up to the end of the financial year as a proportion of the total number of assessments carried out nationally.
Practices will be required to manually input data into CQRS, on a quarterly basis, until such time as GPES is available to conduct electronic data extractions. The data input will be in relation to the payment count only, with zeros being entered in the interim for the management information counts.
For information on how to manually enter data into CQRS, please see the HSCIC website.
Area teams will seek to invite practices to participate in this ES from 1 April 2014.
Practices wishing to participate will be required to sign up by no later than 30 June 2014. Total funding available for this ES is £42 million. Payments will be comprised of two components, with approximately half of the total funding available for each component.
An upfront payment of £0.37 per registered patient. This represents a payment of £2,622.19 to an average-sized practice (where average size is based on a registered population of 7,087).
Payment will be made to practices by area teams on the last day of the month following the month during which the practice agreed to participate in the enhanced service (i.e. by no later than 31 July 2014).
CQRS and GPES will not support payment of component 1 of this service. Area teams must make arrangements for payments locally.
The remaining funding will be distributed as an end of year payment based on the number of completed assessments (using the relevant codes relating to assessments for dementia) carried out by practices during the financial year as a proportion of the total number of assessments carried out nationally under this enhanced service.
The number of assessments carried out be practices individually and nationally will be based on returns to CQRS (automated via GPES or manual end year entry) identifying assessments offered to consenting at-risk patients using the Read code for 'assessment for dementia'
If GPES reports Practice A as completing 192 assessments for dementia during 2013/14 and nationally CQRS calculates that 1,197,408 assessments were carried out in 2013/14, then the end year payment is calculated as follows:
(192 / 1,197,408 ) x £21,000,000 = £3,367
CQRS will be populated with data extracted via GPES (or via manual entry if GPES is not available). The practice and area team will then have until a specified date (to be communicated in due course) to review and amend the data accordingly, with the aim of agreeing it is correct before the specified date. At the specified date, CQRS will then calculate payments, based on the data entered.
There will be no opportunity to amend data after the specified date.
Payments will then be made by area teams accordingly. Payments made under this ES are to be treated for accounting and superannuation purposes as gross income of the practice in the financial year.
The area team will initiate the payment via the payment agency's Exeter system. Due to the nature of the payment mechanism for component 2, there will be no declaration and approval process for this service (apart from that required by practices and area teams pre the specified date as set out above).
Area teams are responsible for post payment verification. This may include auditing claims of practices to verify:
Prepared By Jean Keenan